Shropshire Dyslexia Association:

Subscription Renewal/Application 2011 Form
If you click the Gift Aid box:  your subscription will be worth a lot more. To qualify for Gift aid, the amount you pay in income/capital gains tax must cover the amount we will claim from the Inland Revenue(£2.80 on each £10 worth of subscription).
http://www.hmrc.gov.uk/individuals/giving/gift-aid.htm
Please fill in the details marked with a * ,print out and return to:
Membership, The Roy Fletcher Centre, 12-17 Cross Hill,
Shrewsbury, Shropshire SY1 1JH
First Name:
*
Surname:
*
Address line1:
*
Address line2:

Address line3:

Post Code:               Tel No(+code):
*          *
Email address:

Are you renewing? or joining as a new member?

Fee Type(click box)
-Individual/Family £25  -School £40;-Concessions £12

Cheque No:.........................................Payable to SDA

Signed:.................................................... Date:................
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NB Subscriptions are half price if joining takes place between June-December.

'The information you provide on this form will be used to process your membership. The information will only be passed to the British Dyslexia Association for the purposes of membership and communication as stated in the membership benefits. Please tick this box:if you do not wish your details to forwarded'.

To assist us in providing an efficient and relevant service, and also to give us general membership classification figures that we can use for our lottery bid, we would ask you for the following information:
Dyslexic Member-Child  -Adult
-Male  -Female -Age

School attended/Occupation:.....................................

Hobbies/Interests:.........................................
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